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The obligatory healthcare post

Unlike, I imagine, most of the people participating in the healthcare debate, I have sharp end experience of another system - my father died in a French hospital, and both of my sons were born in a French hospital.

What stands out the most clearly in both instances is that the comfort and so forth of the patient was absolutely uppermost in the consideration of the system, rather than the patient having to adapt to whatever suited the system. My father died of cancer of the lymphatic system a little over ten years ago and spent the last few months of his life in a clinic, undergoing chemotherapy and resting up in a private room with its own bathroom. This, I should add is par for the course for the French system, which is insurance based. My mother got to visit him daily, and to stay in the room for as long as she wished. No 'visiting hours' as such, as there was no risk of my mother inconveniencing other patients, or having other patients' visitors inconveniencing her.

The mother of my children had initial scans and so forth at an NHS hospital in London, but being French preferred to give birth nearer her family. Not unreasonable, one might think. Being a sensitive new man type, and also having the advantage of being a freelancer, I attended the scans, but also went along to a couple of month's worth of NCT ante-natal classes. The NCT woman I would describe as Guardian Woman Incarnate and hardly some dangerous Friedmanite radical, but something that particularly sticks in the mind was her suggestion that her charges should take cleaning materials with them in their overnight bags as all too often the baths at the hospital would be filthy. I am not making this up. When the graduating class was held after the various happy events, every single mother - bar one - had a horror story. Admittedly the women concerned were middle class thirty somethings, more likely to complain the most, and less likely to come up against the public sector than most.

The exception was the mother of my children. #1 son was born in a specialist maternity unit in St Brieuc just under ten years ago although that nearly did not happen. At one of the later scans, a smirking doctor in Tooting relished declaring 'well, maybe we won't let you go to France' when there was the suggestion that there might be complications of sorts. As it turned out there were no complications, but it was made remarkably clear who was the petitioner and who was the petitioned. Fast forward a month, and she was given a tour of the facilities in St Brieuc, a consultation with the anaesthetist etc and a fairly straightforward delivery followed. I was present for the entirety of the time that the mother wanted me to be. After the birth she was given a private room with, apart from its own bathroom, a reclining chair for me to crash out on overnight. The ethos of the unit was that whatever could be done to make the delivery and the aftermath easier and more pleasant for the mother would be central to the process. She stayed in the unit for a couple of days, but was told that she could stay for as long as she liked, as the unit also did research on the post natal condition and so on.

Perhaps the best way of evaluating a maternity healthcare system is the infant mortality rate. In France it is 4.2 per thousand births, here it is 4.8. Given that the extreme is Sierra Leone's 1 in 6, the marginal difference between the UK and France is extremely small.

Bringing it all back home, where I think that the French system has the edge over our own is that is more focused on the patient, rather than the producer. As a middle aged man I do my level best to avoid any dealings with the medical business, and doubtless will die a premature death because of it. However, when dealing with a doctor, as with dealing with a lawyer, a dentist or an optician, or any other tradesman, I am looking to do mutually advantageous business with them - I do not want them to love me, and I am not going to love them.

The Sage of Kirkcaldy interfaced the hammer and the nail to good effect:

"It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their own interest. We address ourselves not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages".

Because public healthcare in the UK operates as 'free at the point of demand', I never get to control where my money goes, and the sawbones cares not one jot whether he or she has my business, and indeed why should they? It makes little difference to their bottom line, as most of us will put up with grubby waiting rooms, receptionists who behave like the mutant spawn of Cerberus and so forth, if we have had the fortune to find a local quack with open books. At the other end of the scale, a resource free at point of demand is always open to abuse / misuse. As I was once told by a doctor, if you fancy your chances of turning up at a surgery to see a quack on spec, go when it is raining - as a sizeable proportion of patients with appointments simply will not turn up


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Blogger Henry North London said... 12:05 pm

Whereas if you see a doctor who needs you to pay him and who you will leave if you do not get good service desires to give you the best service so that you may spread his reputation far and wide and make him a rich man.
We have met have we not in the pub next to the palaces of westminster.

I would not treat anyone in NHS fashion In fact I get screwed because I dont adhere to policy and treat the patient

I have had no complaints in 15 years of practice from my patients.

My co workers frequently complain that I never adhere to policy.

What does that tell you.
I should move to France perhaps?  

Blogger Croydonian said... 12:19 pm

I never tire of telling folk that the BMA attempted a 'strike' so to speak at the prospect of their profession being swallowed whole by the NHS back in 194-whenever.

We have indeed met, sir.  

Anonymous Mr R said... 12:37 pm

Having endured the horror of an NHS clinic this morning I can concur that not all doctors give a damn about the patient, we are treated as an inconvenience and nothing more. As for medical receptionists, don't get me started...

However in defence of the NHS both of my late parents received superlative care from the system. My mother had a liver transplant in 94 at RFH in North London and for the next 8 years received excellent care from the staff there. Indeed she had the same consultants throughout her care and they were not only concerned with her but also her family's wellbeing throughout. I can't thank them enough for their professionalism and dedication.

As I have often commented to Mr C on this subject, it is not the medics to blame, it is the system and the politicians who tie them up in so much paperwork/targets etc. People get treated despite the system not because of it.  

Blogger Croydonian said... 1:53 pm

Mr R - Indeed, I do not doubt that the clinical skill levels are as high here as anywhere else. But I would love to know at which stage they get the master classes in patronising patients.  

Blogger Henry North London said... 2:01 pm

Ive just been in a supervision session being told that I am not following guidelines and that my plans are too organic and that I am not adding social plans.

I retorted that people dont want social plans when they are unwell they want to get better first but no This was biopsycho social modelling

Oh fuck the NHS it has become a stalinist bureacracy

It is becoming hard to be an individual in the system You must operate at a certain level and not be verbose, not have an identity, and perform the rites much like a programmed robot

Fuck them Im not going to bother. I'll do the minimum but thats it I am not a fucking robot and I dont swear that often either now  

Blogger Croydonian said... 2:19 pm

HNL - You have my sympathies, but to adapt a phrase, 'one man with right on his side is always in the majority'.  

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